January 2021 Bloodstream Infection Event (Central Line-Associated Bloodstream Infection and Non-central Line Associated Bloodstream Infection) Table of Contents Introduction…………………………………………………………………………………………………………………………………………….3 Settings……………………………………………………………………………………………………………………………………………………5 Key Terms and Abbreviations…………………………………………………………………………………………………………………..3 Definitions Specific to BSI / CLABSI Surveillance:……………………………………………………………………………………..4 LCBI Hierarchy; Types of LCBIs…………………………………………………………………………………………………………………4 Types of Central Lines for NHSN reporting purposes……………………………………………………………………………….6 Devices Not Considered CLs for NHSN Reporting Purposes: ...................................................................... …6 Table 1: Laboratory-Confirmed Bloodstream Infection Criteria: ................................................................. 7 Table 2: Mucosal Barrier Injury Laboratory-Confirmed Bloodstream Infection (MBI-LCBI)……………………..10 Reporting Instructions: ............................................................................................................................... 13 Blood Specimen Collection…………………………………………………………………………………………………………………….14 Table 3: Examples of Associating the Use of Central Lines to BSI Events (CLABSI): .................................. 16 Pathogen Exclusions and Reporting Considerations: ................................................................................. 19 Table 4: Reporting Speciated and Unspeciated Organisms Identified9 from Blood Specimens ................ 20 Table 5: Examples Illustrating the MBI-LCBI Criteria for Neutropenia ....................................................... 20 Monthly Summary Data…………………………………………………………………………………………………………………………22 Table 6: Examples of Denominator Day counts for Device Days ............................................................... 22 Table 7: Denominator Data Collection Methods ........................................................................................ 25 Data Analyses: ............................................................................................................................................ 27 Standardized Utilization Ratio (SUR):……………………………………………………………………………………………………..28 Rates and Ratios: ........................................................................................................................................ 29 Device Utilization Ratio………………………………………………………………………………………………………………………….29 Descriptive analysis .................................................................................................................................... 29 NHSN Group Analysis: ................................................................................................................................ 29 Group Analysis Resources: ......................................................................................................................... 29 Additional Resources .................................................................................................................................. 30 Table 8: CLABSI Measures Available in NHSN ............................................................................................ 31 References .................................................................................................................................................. 32 Appendix A: Partial List of MBI-LCBI Organisms ........................................................................................ 33 Appendix B: Secondary BSI Guide (not applicable to Ventilator-associated Events [VAE]) ....................... 34 Table B1: Secondary BSI Guide: List of all NHSN primary site-specific definitions available for making secondary BSI determinations using Scenario 1 or Scenario 2 .................................................................................... 38 Secondary BSI Reporting Instructions: ....................................................................................................... 39 Pathogen Assignment ................................................................................................................................. 41 Example 1: Pathogen Assignment .............................................................................................................. 42 4 - 1 January 2021 Device-associated Module BSI Example 2: Pathogen Assignment (continued)……………………………………………………………………………………….43 Example 3: Pathogen Assignment (continued)……………………………………………………………………………………….44 Example 4: Pathogen Assignment (continued)……………………………………………………………………………………….45 Example 5: Pathogen Assignment (continued)………………………………………………………………………………………..47 Figure B1: Secondary BSI Guide for eligible organisms*…………………………………………………………………………49 Figure B2: VAE Guidance for Secondary BSI Determination……………………………………………………………………50 Disclaimer: The appearance of any product or brand names in this training protocol is for educational purposes only and is not meant to serve as an official endorsement of any such product or brand by the Centers for Disease Control and Prevention (CDC) or the United States Government. CDC and the United States Government, by mentioning any particular product or brand, is neither recommending that product or brand nor recommending against the product’s or brand’s use. 4 - 2 January 2021 Device-associated Module BSI Bloodstream Infection Event (Central Line-Associated Bloodstream Infection and Non-central Line Associated Bloodstream Infection) Introduction Although a 46% decrease in CLABSIs has occurred in hospitals across the U.S. from 2008-2013, an estimated 30,100 central line-associated bloodstream infections (CLABSI) still occur in intensive care units and wards of U.S. acute care facilities each year.1 CLABSIs are serious infections typically causing a prolongation of hospital stay and increased cost and risk of mortality. CLABSI can be prevented through proper insertion techniques and management of the central line. These techniques are addressed in the CDC’s Healthcare Infection Control Practices Advisory Committee (CDC/HICPAC) Guidelines for the Prevention of Intravascular Catheter-Related Infections, 2011.2 Settings Surveillance may occur in any inpatient location where denominator data can be collected, which can include critical/intensive care units (ICU), specialty care areas (SCA), neonatal units including neonatal intensive care units (NICUs), step down units, wards, and long term care units. A complete listing of inpatient locations and instructions for mapping can be found in the CDC Locations and Descriptions chapter. Note: CLABSI surveillance after patient discharge from a facility is not required. However, if discovered, any CLABSI with a date of event (DOE) on the day of or the day after discharge is attributed to the discharging location and should be communicated to that facility to encourage appropriate NHSN reporting of CLABSIs. (See Transfer Rule, Chapter 2). Do not collect or report additional central line days after discharge. Key Terms and Abbreviations Refer to the NHSN Patient Safety Manual, Chapter 2 Identifying Healthcare Associated Infections in NHSN and Chapter 16 NHSN Key Terms for definitions of the following universal concepts for conducting HAI surveillance. I. Date of event (DOE) II. Healthcare associated infection (HAI) III. Infection window period (IWP) IV. Present on admission (POA) V. Repeat infection timeframe (RIT) VI. Secondary BSI attribution period (SBAP) VII. Location of Attribution (LOA) VIII. Transfer rule 4 - 3 January 2021 Device-associated Module BSI Definitions Specific to BSI / CLABSI Surveillance: Primary bloodstream infection (BSI): A Laboratory Confirmed Bloodstream Infection (LCBI) that is not secondary to an infection at another body site (see Appendix B. Secondary BSI Guide and CDC/NHSN Surveillance Definitions for Specific Types of Infection [Ch-17], UTI [Ch-7], Pneumonia (Ch-6), and SSI (Ch-9). LCBI Hierarchy; Types of LCBIs (see Table 1 and Table 2): BSIs LCBI 1 LCBI 2 LCBI 3 MBI-LCBI 1 MBI-LCBI 2 MBI-LCBI 3 Secondary BSI: A BSI that is thought to be seeded from a site-specific infection at another body site (see Appendix B. Secondary BSI Guide and CDC/NHSN Surveillance Definitions for Specific Types of Infection [Ch-17], UTI [Ch-7], Pneumonia (Ch-6), and SSI (Ch-9) Secondary BSI Attribution Period (SBAP): the period in which a blood specimen must be collected for a secondary BSI to be attributed to a primary site of infection. This period includes the Infection Window Period (IWP) combined with the Repeat Infection Timeframe (RIT). It is 14-17 days in length depending upon the date of event (see Ch. 2 pages 2-13). Infusion: The administration of any solution through the lumen of a catheter into a blood vessel. Infusions include continuous infusion (for example, nutritional fluids or medications), intermittent infusion (for example, IV flush), IV antimicrobial administration, and blood transfusion or hemodialysis treatment. Access: The performance of any of the following activities during the current inpatient admission: • Line placement • Use of (entering the line with a needle or needleless device) any central line for: o Infusion o Withdrawal of blood • Use for hemodynamic monitoring Notes: 1. If a patient is admitted to an inpatient location with a central line (CL) already in place, and it is the patient’s only CL, the day of first access in an inpatient location begins the central line day count (CL Day 4 - 4 January 2021 Device-associated Module BSI for